Conscientious objection in medicine should not be tolerated

A doctor’s conscience should not be allowed to interfere with medical care, argues an ethics expert in this week’s BMJ.

A doctors’ conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.

Imagine an intensive care doctor refusing to treat people over the age of 70 because he believes such patients have had a fair innings. Or imagine an epidemic of bird flu or other infectious disease that a specialist decided she valued her own life more than her duty to treat her patients. Such a set of values would be incompatible with being a doctor.

The argument in favour of allowing conscientious objection is that to fail to do so harms the doctor and constrains liberty. This is true, says the author, but when conscientious objection compromises the quality, efficiency, or equitable delivery of a service, it should not be tolerated.

He believes that doctors who compromise the delivery of medical services to patients on conscience grounds must be punished through removal of licence to practise and other legal mechanisms.

Values are important parts of our lives. But values and conscience have different roles in public and private life, he writes. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patients.

The door to “value-driven medicine” is a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own, he concludes.

From British Medical Journal

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7 thoughts on “Conscientious objection in medicine should not be tolerated”

  1. Hey, hey, hey! This, like a lot of stories here, is a press release. this one from the British Medical Journal. I don’t think Science Blog is endorsing it, just posting it to encourage debate.

  2. Being pro-choice myself, I can understand where the author and the ScienceBlog editor are coming from. However, I think it philosophically shallow for a “science” blog to be posting such drivel. I do not believe in moral OR ethical absolutes, and the term “should” in the article title is a dead give away that this rant is not scientific. The original purpose of science was to minimize dogma into a compact method, the scientific method, in which we can referee arguments and evidence and revise theories. Many, including the author of this article, instead use pseudo-science as a tool to justify public policy.

    On a more practical note, if a doctor feels that abortion is “doing harm” to a fetus, and you believe that withholding the morning-after pill is “doing harm”, then who can put forth an ABSOLUTE standard to decide? No one; that’s why this debate is still raging.

    Having an “ethics expert” reinforce your views may give you comforting certitude, but it’s not science or logic. All values and ultimate goals are founded on our instinctual urges; logic only helps us achieve those goals. For example, logic alone cannot tell us whether we should work toward world peace, or blow up the earth: it depends on our goal. Only our “un-rational” emotions and primal sympathies can guide us toward some kind of world peace (if such a thing is even possible).

    ScienceBlog, please stick to what you’re good at: science.

  3. This is an outragous article.
    Conscience choice is all that seperates free men and slaves. No doctor should be a slave to his practice. Nor should a so-called Ethics Professional with no values be allowed to force his lack of vision onto others. There is no credibility in his darkness.
    All the ‘what ifs’ postulated in the article are so much smoke, carefully disguising the real issue that is not spoken of, that of abortion on demand, carefully omitted to disguise intent. No doctor should be required to take the life of a fetus if it conflicts with their values. Perhaps the Doctor takes serious his responsibilities to protect life. Just because a law is passed does not lessen the value of that life, nor the conscience of a true professional.
    If anything, this article points out the dangers of Socialized medicine, where doctors lose freedoms in their practice because they in effect become employees of the State, ergo, property of the State. This is slave metality.
    At all counts, a doctor must be free to decline work. The life of the doctor is no less than the patient.
    Any emergency responder is required to evaluate an emergency scene for personal danger. To not do so puts the victim and the responder at greater risk. A doctor must also. This is sometimes a difficult thing, involving the possible lives of the patient or the doctor and the doctors’ family. What doctor would want to bring home some deadly disease to those whom they love because someone else was so afflicted and they were ‘required’ to treat and through some innocent mistake, easily made unknowingly, became infected? How is that thinking rational?
    One of the most important safeguards to our societies is a doctor that has values. Can you imagine a lawyer with no values? Or a politician? (No giggles here!)
    Doctors are trained and educated to make proper medical decisions. They understand their roles. Leave them free to determine their own values, to accept their own level of risk. We have fashioned laws where we don’t want them to go, but let’s not drag them where they don’t want to go.
    Perhaps if they would not perform, you wouldn’t either, given the same variables. Perhaps you would, to your own harm or shame. Perhaps you should be free to make that choice. So should they.
    Some dangers are self evident, some are a matter of conscience. Doctors have to live with the results of their work, and should not be force to do something they find morally repulsive, regardless if the laws allow for it. Perhaps the laws are corrupt! (Remember the lawyers and politicians with no morals? It wasn’t a doctor with principles making some of these laws!)
    He (the Ethics Professional?) ” . . . believes the door to ‘value-driven medicine'(substitute Law for medicine if you will, just for contrast) is a door to a Pandora’s box (with lots of derisive descriptors of those evil values). Public servants (slaves) must (because they are fellow slaves, after all) act in the public interest, not their own.
    The so-called professional from Oxford is 180 degrees wrong. But he can’t be blamed. He received a Socialized miss-education, proving to be yet another victim of a slave State with a fixed slave mentality.
    Perfectly rational, but absolutely incorrect.

  4. This decision sounds fine when the doctor is objecting to a procedure that I have no problem with. But the question isn’t that simple. Doctors in Nazi prison camps were ordered to conduct all sorts of horrible experiments, and mostly complied. If one of them had stood up and disobeyed, and his memory survived, we’d revere him as a hero. Following one’s conscience can never take second-place to shutting up and doing what the authorities tell you to do, and those who follow that principle should be respected, even if they have to be separated from their duties.

  5. You forgot Hitler. It’s an internet requirement when you launch an anonymous, factless, unthinking, self-righteous, ad homen attack on someone you disagree with that you have to compare them to Hitler. Nice touch with Chavez, tho, the swarthy boogie-man down south for right wing tools.

  6. Wow, reading his line of garbage, you would think that the world is full of doctors with ethics and compassion. Shame on their parents and churches.

    Someone needs to get off the high horse and grab a hot cup of reality. There is no shortage of doctor going about their jobs like mindless drones… doing procedures that many would say are ethically questionable.
    Doctors are human beings not machines… although I really wonder what goes on in Medical school. It must be something similar to boot camp where young minds are honed to be capable of the most hateful acts… In the face of death everyday, doctors are trained to be emotionless and the bedside manner of a lump of coal. It’s a dirty job but someone has to do it.

  7. Julian Savulesco is a typical collectivist fool who believes that individuals should be subject to the whim of select representatives of the collective–himself, of course. He represents the collective, so his moral authority is absolute. How could anyone possibly object? When idiots such as Savulesco gain any real authority, have pity on their subjects. The unfortunate subjects of Mugabe, Castro, Kim, Khameini, and Chavez will truly understand their fate.

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